Vestibular nerve section in patients with chronic otitis media

Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.